]]>After a horrible tragedy unfolded at the Hacienda care facility in Phoenix, Arizona, Dr. Marchand was asked by many media outlets to help explain the situation from a medical standpoint, including the extremely unusual case of a woman being pregnant while in a vegetative state. Dr. Marchand has the greatest sympathy for victims of abuse such as described in these events, and hopes that his medical insight can help bring some degree of understanding and closure in this case.

]]>515Dr. Marchand Named SRC’s Featured Designee for January 2019https://gregmarchandmd.com/dr-marchand-named-srcs-featured-designee-for-january-2019/
Mon, 07 Jan 2019 22:00:03 +0000https://gregmarchandmd.com/?p=506Dr. Marchand was named the featured designee for January 2019 by the Surgical Review Corporation, a surgical credentialing organization based in North Carolina. Dr. Marchand very much appreciated the work that SRC does to promote minimally invasive surgery in the USA and around the world. You can read about the award as well as view…

]]> Dr. Marchand was named the featured designee for January 2019 by the Surgical Review Corporation, a surgical credentialing organization based in North Carolina. Dr. Marchand very much appreciated the work that SRC does to promote minimally invasive surgery in the USA and around the world. You can read about the award as well as view the video put together about Dr. Marchand on SRC’s webpage at: http://www.surgicalreview.org/news/dr-greg-j-marchand/

]]>506Dr. Marchand Awarded World Record for Hysterectomy through the Smallest Incision Ever!https://gregmarchandmd.com/worldrecord/
https://gregmarchandmd.com/worldrecord/#commentsMon, 10 Sep 2018 20:35:27 +0000https://gregmarchandmd.com/?p=453Mesa, AZ 08/22/2018 – The World Record Academy today Awarded Dr. Greg J. Marchand a world record for performing hysterectomy through the smallest incision ever. The surgery involved removal of a uterus, ovaries and Fallopian tubes all through an incision the diameter of a AAA battery. The record was awarded after a lengthy verification process…

]]>Mesa, AZ 08/22/2018 – The World Record Academy today Awarded Dr. Greg J. Marchand a world record for performing hysterectomy through the smallest incision ever. The surgery involved removal of a uterus, ovaries and Fallopian tubes all through an incision the diameter of a AAA battery. The record was awarded after a lengthy verification process performed by the academy to verify the results.

Dr. Marchand performed a hysterectomy through an 11mm incision at the bottom of the belly button using a technique called “laparoscopic single-port hysterectomy.” Although laparoscopic hysterectomy has been performed through a single incision before, this is believed to be the smallest incision that it has ever been performed through. The Academy reported that the Mayo Clinic and Cleveland Clinic had reported cases through a 15mm incision, which was believed to be the previous record.

The patient, Mary Coble, provided the Academy with pictures of her belly from 4 weeks after the surgery. There was no scar visible whatsoever. Ms. Coble had suffered from debilitating pelvic pain from endometriosis and adenomyosis for years before being recommended to have the hysterectomy after other conservative treatments for her pain were unsuccessful. She assumed she would be having the hysterectomy through the same incision that she had her cesarean section went through, which was a lower abdomen horizontal incision, often referred to as the “bikini cut.” She states she was surprised and delighted to find that the procedure was able to be performed through only a tiny incision in her umbilicus.

Dr. Greg Marchand, an Accredited Master Surgeon, developed this technique and led the surgical team that performed the surgery. The procedure was a modified version of a laparoscopic hysterectomy, where the only incision used is in the patient’s umbilicus. “A very novel part of our technique,” said Dr. Marchand, “is that because of the instrumentation we use, the incision is always going to be a reproducible 11 millimeters.”

“The recovery was really easy compared to my prior laparoscopic surgeries,” said Mary Coble following the procedure. Mary pointed out that she has no scars at all from the surgery, as the only tiny scar present is on the bottom of her belly button, where it is effectively invisible. Mary has previously had both laparoscopic surgery and delivered her baby by cesarean section, so she is no stranger to recovering from surgery.

“I think it’s a great advancement for minimally invasive surgery.” said Dr. Marchand, the lead surgeon. “When the incision shrinks from 15mm to 11mm, there are many benefits to the patient. There will be less postoperative pain, a quicker postoperative recovery, and a much lower chance of the incision causing a hernia later, which is a known complication of this type of surgery. My favorite part is that you can’t even see the incision on the patient.”

For media requests or more information, please contact Karen Thomas at Thomas PR at (631) 549-7575 or kthomas@thomaspr.com. Dr. Marchand is available for interview and Ms. Coble is also interested in sharing her story and interviewing for the purpose of raising awareness minimally invasive surgery and to help other women facing hysterectomy.

For more information regarding Dr. Greg Marchand, the Marchand Institute for Minimally Invasive Surgery, and their latest research publications, please visit www.GregMarchandMD.com

For more information on the “Master Surgeon” Accreditation, please see the website of the Surgical Review Corporation at www.SurgicalReview.org

Fact Sheet:

Date of Surgery: 07/17/2018

Date of Award of World Record Academy World Record: 08/22/2018

Actual Title of Record: “Total Hysterectomy Performed through the Smallest Incision”

Description of Technical Procedure Performed: Successful Single-port Total Laparoscopic Hysterectomy with bilateral salpingo-oophorectomy and lysis of adhesions secondary to scar tissue from a prior cesarean section. The procedure was performed using an Olympus Tri-Port device using a modified technique through a smaller incision. The incision and abdominal entry was performed using an Ethicon 11mm blunt tip trochar in order to be sure the incision was exactly 11mm, and that the procedure was reproducible. A 5mm 30 degree laparoscope was used with wavy graspers, a bovie laparoscopic extender “hook,” and a Covidien Ligasure Blunt Tipped 5mm device.

Method of Verification of Record: Direct video evidence of procedure and identifying information compared with final pathologic diagnosis by board certified pathologist. Patient consented to disclosure.

Our technique was successful in a difficult case that required dissection of scar tissue from a previous cesarean section, and also entailed scar tissue secondary to endometriosis. Unfortunately, some clinical scenarios involve worse pathology and may require a traditional laparoscopic or robotic assisted laparoscopic hysterectomy in order to be completed. We feel our technique is a valuable weapon in a surgeon’s set of surgical skills but does not constitute a solution for every patient requiring a hysterectomy.

How Would Women Benefit if more Hysterectomies Were Performed Using this Technique?

With LaparoEndoscopic Single Site procedures (LESS), there is only a small scar in the area of the belly button. Because there are less incisions, the healing process is much faster and there is much less postoperative pain. In many cases patients can leave the hospital the same day as the surgery. The cosmesis is also considerably improved, with essentially no visible scars whatsoever. From a surgical perspective, you have a very complete visualization of the abdominal cavity at time of surgery, which is a big advantage for dealing with complex pathology such as endometriosis and fibroids. As a result complications are less common.

What is the invented technique?

The Marchand Institute for Minimally Invasive Surgery acknowledges prior published techniques for single port hysterectomy, also called LESS hysterectomy. There are also suggested techniques for various commercial available products developed for these surgeries. We theorized and performed a surgical technique that utilizes many of the advantages of traditional LESS surgery with an entry that utilizes a bench-marked 11mm blunt laparoscopic trochar port. The end result is a reproducible surgical technique that will continually produce a small incision in the umbilicus of exactly 11mm that is created with a blunt trochar and extremely cosmetic while also providing excellent exposure to the abdomen.

What is the Marchand Institute for Minimally Invasive Surgery, and what do they do?

The Marchand Institute for Minimally Invasive Surgery is a research and educational not-for-profit corporation and functional “Think-Tank” for the advancement of Minimally Invasive Surgery. We are located in Mesa, AZ. Our efforts are split between the publication of high-quality medical research, expert level surgical education, and involvement in clinical trials related to advancing Minimally Invasive Surgery.

Did this record involve “morcellation”?

No. Total Laparoscopic Hysterectomy generally does not require morcellation except in extreme cases, such as Dr. Marchand’s 2008 Guinness World Record. For more details involving the 2008 World Record Please see: https://gregmarchandmd.com/guinness-record-marchand/

What do Dr. Marchand’s accreditations mean ?

The accrediations represent honors bestowed upon Dr. Marchand by different certifying organizations. They include:

MD — Medical Doctor

FACOG — Fellow of the American College of Obstetrics and Gynecology — Certified by The American College/Congress of Obstetrics and Gynecology (acog.org)

FACS — Fellow of the American College of Surgeons — Certified by the American College of Surgeons (facs.org)

FICS — Fellow if the International College of Surgeons — Certified by The International College of Surgeons (fics.org)

Accredited Master Surgeon – Dr. Marchand is currently the only Accredited Master Surgeon in Arizona, — Certified by the Surgical Review Corporation (surgicalreview.org)

Why is this a world record? Can’t a hysterectomy be done with no abdominal incision at all?

Yes, a hysterectomy can be performed vaginally without any abdominal incisions at all in uncomplicated cases without significant pathology. A completely vaginal approach, however, gives a very limited view of the abdomen and makes it difficult to deal with abdominal pathology such as scar tissue from prior surgeries and scar tissue from endometriosis. This can increase the chance of complications and injuries to surrounding organs. Using our technique we were able to directly visualize the abdominal cavity and perform the hysterectomy with less risk of complications. This was demonstrated by our ability to complete the hysterectomy safely despite this patient’s history of prior cesarean sections and endometriosis. Our technique also has excellent cosmesis using only an 11mm incision that leaves essentially no scar.

How can you be sure that this is the smallest incision a laparoscopic Hysterectomy has ever been performed through? What steps did you take to verify?

We performed extensive searches of the literature in all of the relevant journals as well as PubMed. We were not able to find any reported case of total hysterectomy performed solely through this small of an incision. The World Record Academy then went on to verify the claim independently. We were awarded the record after the completion of their exhaustive verification efforts.

————————-

For media requests or more information, please contact Karen Thomas at Thomas PR at (631) 549-7575 or kthomas@thomaspr.com. Dr. Marchand is available for interview and Ms. Coble is also interested in sharing her story and interviewing for the purpose of raising awareness minimally invasive surgery and to help other women facing hysterectomy.

For more information regarding Dr. Greg Marchand, the Marchand Institute for Minimally Invasive Surgery, and their latest research publications, please visit www.GregMarchandMD.com

For more information on the “Master Surgeon” Accreditation, please see the website of the Surgical Review Corporation at www.SurgicalReview.org

Olivia Orano has just delivered baby Myles, a beautiful 7lb baby boy! Like any first time mothers, during the pregnancy, Olivia spent a lot of time developing a “birth plan,” or a list of her preferences at time of delivery. That list originally included avoiding induction of labor and “letting the baby come naturally.”

At six months of pregnancy, however, Olivia had a discussion with her OBGYN that changed that plan. Her OBGYN, Dr. Greg Marchand, told her about a recent study that gave new information about first time moms, and how they could maximize their chance of delivering vaginally and avoiding cesarean sections.

“I was always taught in my training that it was best to wait for labor, no matter how long that took.” Said Dr. Marchand, a leading Arizona OBGYN. “I was taught that the way to maximize the patient’s chance of a vaginal delivery was to avoid induction and let the woman go into labor naturally. We couldn’t have been more wrong! If you’re pregnant with your first baby, and you want to have your baby vaginally, you should be induced no later than 39 weeks. For years, all Obstetricians, including myself, have been counselling our patients that they should wait for labor. At least for first time mothers, this is now clearly not the best idea.”

The landmark study came from the government funded National Institute of Child Health and Human Development (NICHD). The results showed that those first time moms randomized to be induced at 39 weeks had a lower rate of cesarean section, and had babies that did better after birth. The study seemed to prove that the definitive factor in whether a woman will deliver her baby vaginally or by cesarean section is the weight of the baby. This stands in contrast to decades of traditional Obstetrical education which taught that cervical dilation was the real determinant.

Cervical dilation or “ripeness”, refers to how open, or how soft the cervix is. Up until this point many Obstetricians would use this solely as the determinant for when to induce labor. The study was sponsored by the National Institute of Health and prospectively reviewed the outcome of greater than 6000 births of first time mothers. About half of those mothers were scheduled for induction at 39 weeks, the other half were left to go into labor naturally whenever it would come. The surprising outcome was a 16% decrease in cesarean section in the women in the electively induced arm of the study. The babies born to the electively induced babies also had a lower incidence of respiratory problems, and overall needed help breathing less often than the babies in the “natural labor” arm.

Dr. Marchand went on to explain that this research will greatly change the way doctors counsel their pregnant patients at time of delivery, and that it will result in many more women being induced at 39 weeks gestation.

For Olivia, she was moved by the discussion and decided to go forward with induction at 39 weeks. She was able to have baby Myles naturally, and couldn’t be more in love with her new baby!

Ms. Orano is interested in sharing her story with the news media for purposes of awareness. For media and interview requests contact Maria Sainz at Maria@GregMarchandMD.com or 480-999-0905

]]>357Broken Play Laparoscopy – What to do when there’s no findings?https://gregmarchandmd.com/broken-play-laparoscopy/
https://gregmarchandmd.com/broken-play-laparoscopy/#commentsMon, 02 Jul 2018 07:01:44 +0000https://gregmarchandmd.com/?p=438Any surgeon who has done enough laparoscopy has been there. In the office it seemed like the patient had all the classic signs of endometriosis. She had a family history of endometriosis, the pain was worse during intercourse, worse during her period, there might have a even been a little hemorrhagic cyst that looked “oh-so-close”…

]]>Any surgeon who has done enough laparoscopy has been there. In the office it seemed like the patient
had all the classic signs of endometriosis. She had a family history of endometriosis, the pain was worse
during intercourse, worse during her period, there might have a even been a little hemorrhagic cyst that
looked “oh-so-close” to an endometrioma on ultrasound. But you got the scope in and her abdomen is
cleaner than a self-reported surgical complication list. Other than just waking up the patient and
explaining the pain must not be from gynecologic causes, what do you do? In football we have a
scenario very much like this – we call it a “Broken Play.” Basically the quarterback gets the ball and
whatever was supposed to happen that play, be it a handoff or pass suddenly cannot happen. It could
be because of unexpected coverage, or it may be the running back tripped or the receiver ran the wrong
route. Whatever the reason, the quarterback ends up with the ball in a collapsing pocket, wondering if
there’s any way he can make something good happen out of the horrible turn of events that have
unfolded for him. I’ve heard many ideas about what to do in this scenario, so I’ll cover a few of them in
detail.

“Almost” Incidental Appendectomy

We all know that appendix is going to look a little injected. Does that mean it deserves to go? Do you
even have privileges to remove it at this hospital (or surgery center?) The nurse thinks that there’s a
general surgeon a few operating rooms over, or in the cafeteria, or living just “5 minutes away.”
Generally, suspicion of acute appendicitis is considered an emergency that does not require advanced
consent. While I agree the temptation may be strong, I recommend not to perform the incidental
appendectomy unless you really feel there are compelling signs of inflammation. Proactively, however, I
do recommend discussing the appendectomy with all patients who have primarily right sided pelvic pain
before surgery, although I can’t say I always remember to do it. It really should be something to think
about consenting the patient for whenever you are going in for right sided pelvic pain without a clear
cause. I recommend going so far as to asking the patient ahead of time “if I don’t find anything, would
you want your appendix removed? ”

“Desperation” Ovarian Cystectomy

As gynecologic surgeons we are sometimes put in a real dilemma as to whether or not to remove a
normal appearing ovary that really seems like the cause of the pain. If you’re like me, it really takes a
high threshold to remove an otherwise normal appearing ovary, just because it is assumed to be the
unproven cause of the patient’s pain. Cystectomy, on the other hand, backed by clinical suspicion, can
appear as a seemingly free move in the uncomfortable case of a laparoscopy devoid of findings. We can
always find a small follicle that could be the cause of the pain, right? With less than a third of ovarian
tissue being required to maintain hormonal support, one could also ask the question of why you would
not try to fix the patient’s pain with a generous ovarian cystectomy? After all, you are already in her
abdomen! The answer, of course, lies with our hippocratic responsibility, and the possible damage to
the women’s future fertility, as well as the unlikely, but possible loss of the ovary.

Intra-Abdominal Local Anesthetics

Although supported by a paucity of data, the intra-abdominal use of marcaine or other local numbing
agents, whether sprayed at the target area of pain, or simply injected into the abdominal cavity, can
considered in the absence of other treatable causes of pelvic pain. The logic, at least, makes sense. The
possibility of interrupting a theoretical abhorrent neurologic pathway that was eternally fixed on
reporting horrific non-existent pain may seem tempting and without risk, but some pitfalls must be
understood. cJust as we are able to perform dialysis using the physiology of the abdomen, fluid in the
abdominal cavity can quickly become intravascular. High doses of these medications can cause Local
Anesthetic System Toxicity, (LAST Syndrome) so you will need to know your patient’s weights off hand
for safe, effective usage. With the exception of this caveat, there is little harm in using small doses of
local anesthetic in the abdomen.

Gentle Hydrodistention

The jury is still out as to whether an old fashioned gentle hydrodistention of the bladder is a good way to
diagnose and treat interstitial cystitis. There is no doubt, however, that quite a few patients will give a
very impressive display of bladder petechial lesions after being stretched to about the 300cc mark.
Whether all those patients have pain from IC is another story. With the high correlation between
interstitial cystitis and endometriosis, it certainly makes sense to continue your quest to find the cause
of your patient’s pain in the bladder after coming up empty handed in the pelvis. This almost risk-free
exploration makes an attractive go-to for any pelvis who’s pain could be explained by a condition in the
bladder.

Close up and Declare Victory

Is there anything wrong with just dessufflating the abdomen and hoping that the sheer act of having
insufflated it will help with your patient’s pain? While probably just wishful thinking on our parts as
surgeons, there is some data behind the placebo effect of laparoscopy even in the absence of
discovered pathology.

I have heard many of my colleagues tell family members in the waiting room
that if you just tell her “they fixed everything,” when they wake up – they will feel a ton better. I’m
honestly not sure whether this is the power of positive thinking or straight-forward dishonesty.
Nonetheless, a placebo effect can never be completely discounted, and there probably isn’t much use in
telling a patient that she definitely will not feel better after her surgery.

In conclusion, I hope you, me, and all our colleagues never find ourselves operating with no explanation
for a patient’s pelvic pain, or in a “Broken Play Laparoscopy” as I have described it. I would encourage
those of you that do find yourself in this situation to consider your next moves based on your training,
intuition, and what little evidence you find available. I can only hope that I may have helped with a little
insight into this difficult scenario.

]]>https://gregmarchandmd.com/broken-play-laparoscopy/feed/1438Dr. Marchand’s Advanced Surgery Saves Baby and Mom with Rare Pregnancy Complicationhttps://gregmarchandmd.com/heterotopic/
Wed, 06 Jun 2018 00:26:17 +0000https://gregmarchandmd.com/?p=425Dr. Greg J. Marchand MD performed an advanced minimally invasive surgery on a pregnant Phoenix area woman, who later went on to deliver a healthy baby seven months later. The woman suffered from a very rare condition called a “Heterotopic Pregnancy.” A heterotopic pregnancy is a rare pregnancy complication when two simultaneous pregnancies are in…

]]>Dr. Greg J. Marchand MD performed an advanced minimally invasive surgery on a pregnant Phoenix area woman, who later went on to deliver a healthy baby seven months later.

The woman suffered from a very rare condition called a “Heterotopic Pregnancy.”

A heterotopic pregnancy is a rare pregnancy complication when two simultaneous pregnancies are in separate implantation sites, occurring both inside and outside the uterus.

The life saving procedure was called a “Laparoscopic Salpingectomy,” which means to remove a fallopian tube from the abdomen through small holes. Although this technique is commonly performed in the US, it is very rare to perform the technique on a patient with a pregnancy also in the uterus.

Dr. Marchand was able to perform the surgery through two very tiny “keyhole” size incisions. Although minimally invasive surgery to treat extra-uterine pregnancies is not unusual, this case was extremely rare as it was necessary to avoid harming the pregnancy inside the uterus while removing the pregnancy in the fallopian tube. If the emergency surgery was not performed, the pregnancy in the fallopian tube would rupture causing internal bleeding. This could be fatal for mom. Untreated extra-uterine, (or ectopic) pregnancies are the number one cause of maternal death in pregnancy in the United States.

“It’s an extremely delicate technique.” Said Dr. Marchand, describing the surgery. “You have to be very care not to use certain electrical energies or manipulators that could harm the pregnancy inside the uterus. You also have to be very careful with the pregnant uterus. You can’t move it around or push on it too much, or you could cause a miscarriage. You also have to be careful about how you remove the fallopian tube from the uterus. If you use too little electrical energy you could run into heavy bleeding, and if you use too much, or the wrong type, you could overheat or even burn the uterus and it’s precious cargo!”

Heterotopic pregnancies are extremely rare – occurring only a few times every million pregnancies in the US. When they do occur, they threatened both the lives of the mother and the baby in the uterus. In this case, however, mom went on to deliver a beautiful baby 31 weeks after the surgery!

]]>425Will Cocoa Butter Cause Heart Defects In Your Baby?https://gregmarchandmd.com/will-cocoa-butter-cause-heart-defects-baby/
Tue, 29 May 2018 07:01:02 +0000https://gregmarchandmd.com/?p=416As an OBGYN one of the most common office questions is the infamous “Is this safe in pregnancy?” From hair dye to caffeine, cold cuts to vaping, Obstetricians in the US must constantly be ready to give our opinions on food, medication, hygiene and beauty products for our pregnant patients. While I am usually ready…

]]>As an OBGYN one of the most common office questions is the infamous “Is this safe in pregnancy?” From hair dye to caffeine, cold cuts to vaping, Obstetricians in the US must constantly be ready to give our opinions on food, medication, hygiene and beauty products for our pregnant patients. While I am usually ready to provide my instant canned responses to almost any question, I was intrigued earlier this year when a new question entered the mix that even I had not heard before.

Three times so far this year, patients have asked me if Cocoa Butter was safe to apply during their pregnancy. I was very accustomed to the question “Will Cocoa Butter prevent stretch marks?” (Which it won’t, by the way,) but up until this year I had never heard anyone even suggesting that the most common skin cream used in pregnancy could be harmful. As a result, I hit the books and sought out to be sure I had the best answer for my patients.

Like any good urban legend, I quickly found there actually was a tiny bit of evidence to at least spark the idea that this statement could be true. That smidgen of evidence comes in the form of a study published in 2006 by a small team of researchers from the Albert Einstein Medical Center in Philadelphia, PA. This team submitted a research paper to the Annual Meeting of the Society of Maternal Fetal Medicine in Miami, Florida. The title of this paper was “An association between fetal arrhythmias and maternal use of cocoa butter.“ It was accepted and presented at the meeting. Like all studies at that meeting, it was also later published in a special edition of the American Journal of Obstetrics and Gynecology, which most physicians in this field simply refer to as “the gray journal.”

The purpose of this discussion is not to discredit the study itself, but rather to point out that the study in no way ever proposed that Cocoa Butter could cause fetal heart birth defects. The study, which was a retrospective unblinded analysis of 255 patients, only included the rare patient that had both an RSP (Redundant Septum Primum,) and suffered from PACS’s (Premature Atrial Contractions). For this rare and unusual patient set, the study basically went on to say that the PAC’s (the arrhythmia portion) may be caused by exposure to Cocoa Butter, or other caffeinated foods. They stated this was only applicable in patients who already had an RSP. The study also defined what an RSP was, calling it any septum primum that could reach at least half the way to the far wall of the left atrium. Prior to this study no one had specifically defined what exactly an RSP was, or it’s involvement in PACS. The study never actually theorized, or was even set up to tell if the two identified variables, Cocoa Butter Lotion and Caffeinated Food Products actually caused the defect described as Redundant Septum Primum, or any other birth defect.

The study actually was developed to measure whether discontinuing usage of these two substances would decrease the incidence of PAC’s in mothers who were already suffering from both of these conditions simultaneously, and ultimately claimed to show that stopping these agents did indeed have that effect. The obvious flaw here is that there is no evidence of causality to begin with, meaning we don’t really know if agents are the cause of the PAC’s to begin with.

From a scientific perspective, the study was flawed in numerous ways. First, there was no control group at all. Every patient included in the study already had both a RSP and PAC’s. There was no quanitification of what percentage of PAC’s would resolve without any intervention, only the observation that ceasing usage of the substances fixed the problem in most of the experimental group. Without a control group there was no way to know if these PAC’s were all just destined to resolve spontaneously anyway, and that the Cocoa Butter was snatched unnecessarily. There was also no attempt to find any connection between the formation of the RSP and use of the substances, and no attempt to find the overall incidence of RSP, something that has not been studied since.

In conclusion, even if this study was correct in all it’s assertions, (that caffeine causes PAC’s in the rare patient that has an RSP,) it most certainly does not blame caffeine or Cocoa Butter for causing the RSP, or any other birth defect.

As a result I feel completely justified in telling my patients that Cocoa Butter has most certainly never been shown to be associated with any birth defects, and you should be too! Also, if you were wondering, Cocoa Butter is not going to be particularly useful against stretch marks unless you combine it’s usage with the type of “slow and steady” weight gain Obstetricians recommend in pregnancy.

About Dr. Marchand:Dr. Marchand is recognized internationally as a pioneer in developing laparoscopic techniques, as well as an expert minimally invasive surgeon and teaching surgeon. Dr. Marchand is originally from Providence, RI, and is board certified in Obstetrics and Gynecology. Dr. Marchand was recently honored with a World Record for removing a 17cm Malignant tumor using a special laparoscopic cancer staging technique he invented. Dr. Marchand was also one half of the team that was recognized by the Guinness Book of World Records(TM) for removing a seven pound uterus without needing to cut open the patient. Dr. Marchand was the first surgeon in Arizona to receive the “Master Surgeon” designation from the Surgical Review Corporation. In addition, Dr. Marchand is one of the few OBGYN’s in the country to be a fellow of both ACOG (American College of Obstetrics and Gynecology) and ACS (American College of Surgeons.) When he is not in the operating room, Dr. Marchand enjoys low carb living and chasing around his five year old son, Sebastian. For further Information about Dr. Marchand’s research and practice please visit www.GregMarchandMD.com, or reach Marchand OBGYN at 480-999-0905.

About the Referenced Study:

Further information regarding the published study discussed above can be found at the corresponding DOI at this address: https://doi.org/10.1016/j.ajog.2006.10.635. Dr. Marchand has no affiliation with the authors of this study or the publishing entities.

]]>416Rutgers University New Jersey Medical School Includes Dr. Marchand’s Surgical Techniques to Their Core Competencies in Obstetrics and Gynecologyhttps://gregmarchandmd.com/rutgers-university-new-jersey-medical-school-adds-dr-marchands-surgical-techniques-core-competencies-obstetrics-gynecology/
Sun, 18 Feb 2018 15:00:01 +0000https://gregmarchandmd.com/?p=383In February 2018, Rutgers University New Jersey Medical School in New Brunswick, NJ, added Dr. Marchand’s surgery of placing a laparoscopic cervical cerclage to their list of Core Competencies for medical education. Dr. Marchand is very honored that his colleagues in the Garden State chose his research to help educate their students and residents. Dr. Marchand…

]]>In February 2018, Rutgers University New Jersey Medical School in New Brunswick, NJ, added Dr. Marchand’s surgery of placing a laparoscopic cervical cerclage to their list of Core Competencies for medical education. Dr. Marchand is very honored that his colleagues in the Garden State chose his research to help educate their students and residents. Dr. Marchand firmly believes that education is the most important of promoting minimally invasive surgery in the United States.

The World Record Academy recently awarded Dr. Greg J. Marchand and his surgical team a world record for removing a 17-centimeter cancerous ovarian tumor using only small incisions in the abdomen, a technique called a laparoscopy. While removing cysts and tumors using laparoscopic surgery is a standard practice, Dr. Marchand said it is rare to use the technique in conjunction with an ovarian cancer staging procedure.

The surgeons completed the procedure using “in-bag” morcellation, a technique developed by Dr. Marchand in which the tumor is bagged and broken down inside the bag so the pieces can be safely removed through tiny holes. Otherwise, patients would need a sizeable incision to surgically remove such a large mass, requiring additional recovery time and a great deal more postoperative pain.

Marchand, a board-certified OB-GYN specializing in “minimally invasive surgery,” worked closely with a gynecologic oncologist in completing this amazing surgery.

Marchand said the most difficult part of the surgery was removing the cancerous mass without spilling any cancer cells into the abdomen. If cancerous material spilled back into the abdomen the cancer could have spread and worsened the patient’s prognosis. The World Record Academy helped verify that this type technique had never been accomplished previously on any malignant tumor this large.

Dr. Marchand was diagnosed in 2010 with mixed-cell carcinoma, (an aggressive cancer of the testes,) said it is particularly gratifying that his technique can help cancer patients. He received surgery and treatments in 2010 has been in remission since.

“I know what it’s like to face a diagnosis of cancer,” he said. “In my opinion, advancements in the surgical treatment of cancer are just as important as the newest cancer-fighting drugs and chemotherapy agents.”

“If we can use minimally invasive surgery to take some of the recovery time and complications out of cancer surgery, then I think we’ve really done a lot of good for patients fighting cancer.”

This is Dr. Marchand’s second world record in laparoscopic surgery. In 2008 Dr. Marchand was awarded a Guinness World Record for the removal of the largest uterus laparoscopically. In this case, it was not a cancerous mass, but a seven-pound benign (non-cancerous) uterus that was removed.

In addition to the two world records, Dr. Marchand is extensively published in laparoscopic surgery and was recently the first U.S. surgeon to receive SOEMIS recognition, (Surgeon of Excellence in Minimally Invasive Surgery) from the Surgical Review Corporation (surgicalreview.org). (Formerly sponsored by AAGL. (The American Association of Gynecologic Laparoscopist’s) AAGL.org). Dr. Marchand is internationally regarded as an expert in developing and performing advanced surgical techniques, particularly in minimally invasive surgery. For further information regarding Dr. Marchand and his publications and research please visit www.gregmarchandmd.com

Fact Sheet:

Date of Surgery: 04/21/2015

Date of Award of World Record Academy World Record: 1/27/2017

Actual Title of Record: “Successful Laparoscopic Ovarian Cancer staging Surgery on the Largest Malignant Ovarian Tumor”

Description of Technical Procedure Performed: Successful Complete Laparoscopic Ovarian Cancer Staging Procedure with Hysterectomy, Bilateral Salpingo-oophorectomy, omentectomy and dissection of pelvic and para-aortic lymph node dissection, and removal of 17cm large right-sided ovarian tumor. The tumor was found to be adenocarcinoma on frozen section and “Well-differentiated Adenocarcinoma with pushing invasion” on final pathology. The technique of mass removal was a modified “in-bag” morcellation invented by Dr. Marchand which included exteriorization of the mouth of the bag prior to “in-bag” morcellation. Morcellation used only blunt instruments and did not involve stretching the incision beyond the 14mm required to facilitate the laparoscopic retrieval bag. No trochar was used. Abdominal and Pelvic washings were collected prior to the removal of the mass and ultimately proved negative.

To verify this record, we had to research all the other related surgeries that had been published to determine if ours was truly the largest malignant tumor ever surgically staged through completely laparoscopic means. After our research determined it was, we employed the World Record Academy who underwent their own verification process. Following the completion of these two independent verifications, we can now confidently say that this is likely the largest malignant ovarian tumor to ever undergo completely laparoscopic surgical staging.

What is “In-Bag” morcellation, how is it different from just breaking something apart, or regular morcellation?

In-Bag morcellation refers to the surgical technique of placing an object inside a bag, usually plastic, before breaking it into pieces. Usually the object is broken into small pieces so that it can be removed through small holes, thus not needing to make a large incision to remove the object. This high level of caution is reserved for objects that could contain cancerous cells. In the case of suspicion of cancerous cells, it is important not to spill the material back into the patient’s body cavities because cancer cells can “Seed” or begin new cancer colonies if they are moved around the body. In this case, we removed a 17-centimeter cancerous tumor through a hole that was approximately 1.4cm large. This technique is one of the more extreme examples of “In-Bag” morcellation.

What did Dr. Marchand invent? Did he invent laparoscopy or the Ovarian Cancer Staging Procedure?

Dr. Marchand has pioneered techniques for “In-Bag” morcellation, and particularly the technique used in this case to remove the large 17cm tumor. The technique used here involved stretching a 1.10cm incision in the umbilicus to facilitate a bag that was made to fit a 1.5cm port. Thus, the actual size of the hole after stretching around the bag was approximately 1.4cm. This invented technique also included the painstaking process of removing the mass through the port without breaking the bag. This included the use of special blunt instrumentation to remove the tumor without breaking the bag (and spilling the tumor.) Dr. Marchand did not invent laparoscopy or the Ovarian Cancer Staging procedure, but he did invent the technique of removing the large cancerous tumor, which was then added to a Laparoscopic Ovarian Cancer staging procedure.

Is Dr. Marchand a gynecologic oncologist?

No. Dr. Marchand is a generalist OBGYN with special training in minimally invasive surgery. A board certified gynecologic oncologist was present for this surgery as part of the surgical team. Dr. Marchand routinely includes consultation with the gynecologic oncology service as part of his care of any patients suspected to have a malignancy. Dr. Marchand would never attempt to perform an ovarian cancer staging surgery without the assistance of a gynecologic oncologist, and is very appreciative for the patient care that has been given his colleagues. Dr. Marchand has referred many patients and continues to refer to his esteemed colleagues practicing gynecologic oncology.

What do the letters after Dr. Marchand’s name mean?

The letters represent honors bestowed upon Dr. Marchand by different certifying organizations. They include:

MD — Medical Doctor

FACOG — Fellow of the American College of Obstetrics and Gynecology — Certified by The American College/Congress of Obstetrics and Gynecology (acog.org)

FACS — Fellow of the American College of Surgeons — Certified by the American College of Surgeons (facs.org)

FICS — Fellow if the International College of Surgeons — Certified by The International College of Surgeons (fics.org)

Why is this record recognized by the World Record Academy and not Guinness?

Dr. Marchand has previously received a World Record from Guinness for other surgical accomplishments. Unfortunately, Guinness politely declined to recognize this achievement and said it was too specific to create a record for. We discussed the importance of recognizing cutting-edge surgical excellence in the field of cancer surgery with The World Record Academy, and they agreed to recognize the category after extensively researching the accomplishment.

What is a “Cancer Staging Surgery?”

A cancer staging surgery is a removal of the pelvic organs to treat and determine how far a cancer has spread. In this case the cancer is an ovarian cancer we are discussing. The surgery includes removal of both ovaries, the uterus, the omentum (a fatty organ in the abdomen) as well as the removal of lymph nodes and other biopsies. It is a complex surgery that is usually performed through a large incision. Although the surgery has been performed by laparoscopic techniques in the past, we believe this is the largest tumor to ever be staged using a completely laparoscopic technique.

What is so special about this record? Hasn’t cancer staging surgery been performed on larger ovarian tumors?

Yes, staging procedures have been completed on larger tumors, but we believe that this is the largest tumor to ever be staged through entirely laparoscopic techniques, meaning without cutting the patient open. The unique part of this procedure was the removal of the extremely large mass without spilling any of the contents in the abdomen. This was performed with special instruments using a large bag. The technique involved exteriorizing the mouth of the bag and then removing the large mass bit by bit, using a technique pioneered by Dr. Marchand. There is no question that larger tumors have been staged by open-incision procedures, and that larger non-malignant tumors have been removed laparoscopically without the need for a cancer staging procedure.

How can you be sure that this is the largest tumor to ever receive laparoscopic cancer staging? What steps did you take to verify?

It is very difficult to research every single cancer staging procedure ever performed. However, we performed extensive searches of all available literature and publications regarding laparoscopic ovarian cancer staging surgery prior to presenting our claim to The World Record Academy. The World Record Academy then went on to verify the claim independently.

How would the average ovarian cancer patient benefit if all staging procedures could be performed though minimally invasive means?

If all ovarian cancer staging procedures could be performed using laparoscopic means, patients could enjoy much faster recovery from surgery, with a much quicker return to a high quality of life. This would mean that patients could begin any necessary chemotherapy or radiation treatments sooner, and be healthier when they undergo these treatments. The overall goal would be a lower mortality and higher quality of life for patients facing a malignant diagnosis.

What gave you the idea to invent this technique?

“Well, I have done hundreds and hundreds of laparoscopic cases where I removed benign ovarian tumors, and as a responsible surgeon I had to come up with a technique to remove these large masses while keeping all of morcellated pieces contained. This was especially after all of the negative attention that morcellation has received following the 2014 FDA “Black Box Warning”. As a minimally invasive surgeon, I knew that simply cutting the patient open was not the best I could do for my patients. After studying some other in-bag morcellation techniques, I developed this technique which has the versatility to be used on even extremely large masses.”

What gave you the idea to qualify for a world record?

“The idea first came to me after talking to some of my friends and colleagues about the huge tumor that we performed the laparoscopic cancer staging on. Upon hearing about the 17cm tumor we removed with in-bag morcellation, I was really humbled to hear many of them say that they had never heard of a minimally invasive cancer staging surgery on that large of a mass. One of my colleagues actually said, “That has to be some kind of record.” It kind of stuck in my head, so after I talked about it with my office staff, some very smart and motivated people at my office actually DID check to see if it was a world record, and published it. I’m very grateful to my amazing clinical staff, and I really do hope this helps bring attention to promoting minimally invasive surgery.”

What does this technique mean for Ovarian Cancer patients with large tumors?

“Well, the In-Bag morcellation technique itself is great for large tumors whether they are malignant or benign, and allows you to remove extremely large tumors through a small hole, actually smaller than a dime. The other option, which is cutting the patient open, has more postoperative pain, more complications and blood loss, and a lot longer recovery. So all patients who receive minimally invasive surgery will benefit. When you combine this technique with a laparoscopic cancer staging procedure, well thats when you see a real amazing improvement. You take a large, invasive procedure that has always be performed through a large painful incision, and you change it into a “keyhole” surgery that a patient could even have on an outpatient basis. That’s a big difference. Interestingly, just recently the National Cancer Institute of Milan in Italy just released their study on the differences between laparoscopic ovarian cancer staging and the traditional open procedure. After reviewing more than 3000 cases, they found that the laparoscopic procedures were just as good in treating the cancer, and had less blood loss, fewer complications, and a quicker recovery. Most importantly, they showed that patients who also needed chemotherapy for their cancer were able to begin their chemotherapy significantly sooner after laparoscopic staging than those who had traditional open procedures. This means less time for the cancer to spread, and a quicker return for that patient back to what they really want, their normal lives back.”

What does this mean to you as a cancer survivor?

“I underwent surgery and treatments after I was diagnosed with Mixed Cell Testicular Cancer in 2010. I am very lucky that the surgery for my stage of Testicular cancer was a very minimally invasive procedure, and that I had a good surgeon. I remember the horrible fear of “just not knowing what was going to happen,” and I think that fear is really worse than any of the pain of the cancer or the treatments. When I woke up from the surgery, I really felt great, and over the next few days I had a very quick recovery. I was able to get back into my life quickly, and although I was still afraid of what was to come, I felt like I had the strength to fight. When I think about my patients with Ovarian cancer, I would like them to be able to come out of surgery feeling like they have the strength to fight, to take on the cancer. I can imagine that when you are recovering from a one of these big, open traditional staging procedures, you’re in excruciating pain, you really can’t move, and you like you’ve just been hit by a bus. I’m sure you don’t feel strong and ready to fight the cancer at that point. You might just feel like giving up. If my technique can help even a few patients avoid that feeling, then thats the most valuable thing in the world to me. That’s why I’m really passionate about what this new cutting edge technique can do for cancer patients, and I feel it can be just as valuable in the fight against cancer as the latest “big pharma” wonder drug.

How can I find out more details?

Please contact the Marchand OBGYN PR department at the below address. Patient privacy limits details that can be disclosed but all information is available for fact-checking purposes.

]]>220Dr. Marchand sets Guinness World Record™ for Laparoscopic Removal of Largest Uterus Ever!https://gregmarchandmd.com/guinness-record-marchand/
Sun, 01 Jan 2017 19:00:41 +0000https://gregmarchandmd.com/?p=202Dr. Marchand and another surgeon received a Guinness World Record™ in 2008 for their accomplishment of removing a huge uterus without needing to resort to cutting the patient open. The surgeons removed a 3200 gram (approximately 7 pound) uterus without resorting to laparotomy (cutting the patient open.) This surgery utilized an advanced “minimally invasive” surgical technique called “Laparoscopy,” where surgeons…

]]>Dr. Marchand and another surgeon received a Guinness World Record in 2008 for their accomplishment of removing a huge uterus without needing to resort to cutting the patient open. The surgeons removed a 3200 gram (approximately 7 pound) uterus without resorting to laparotomy (cutting the patient open.) This surgery utilized an advanced “minimally invasive” surgical technique called “Laparoscopy,” where surgeons use small “keyholes” in the patient’s abdomen to perform the surgery instead of cutting them open. Although Laparoscopic Surgery and other minimally invasive techniques are being used more and more frequently throughout the country, this is believed to be the largest uterus ever removed without cutting a patient open, shattering the previous record of 3050 grams.

“It’s all about the patient,” Said the surgical team leader Richard Demir MD. “With minimally invasive surgery patients recover faster, and can be back to work in a few days – not the weeks of recovery a traditional hysterectomy needs. We are please that Guiness is recognizing us for our achievement, but the real achievement is the thousands of women annually that are helped by these surgeries.”

Advantages of Minimally Invasive Surgery over traditional “Cut the patient open”surgery include faster recovery, less blood loss, fewer serious complications, and less post operative pain. Not all surgeons can perform these advanced techniques. Despite all of these advantages, of the estimated 600,000 hysterectomies performed in the US each year, less than one third utilize these techniques. The main barrier to availability seems to be finding doctors that are surgically capable and willing to perform these procedures, which often carry no monetary incentive to the surgeon.

“I hope this world record brings attention to minimally invasive surgery,” said Greg Marchand MD, the other half of the surgical team. “There are far too many women being cut open when they just don’t need to be.”

Both Dr. Demir and Dr. Marchand are licensed physicians and surgeons in Arizona.